預防乳腺癌病人上臂植入式輸液港感染的循證實踐

Evidence-based practice of prevention of arm implantable port-related infection in patients with breast cancer

WANG Huixin，HUANG Limei，FU Youyuan，LIU Yangchen，ZHAO Huihui，WU Jiahua，ZHOU Chunjiao，WEI Lin，LIN Meizhen，ZHANG GuangqingGuangdong Provincial Hospital of Traditional Chinese Medicine，Guangdong 510120 ChinaCorresponding Author HUANG Limei，E-mail：hlm7711@163.com

Abstract Objective：To carry out the evidence-based practice of prevention of arm implantable port-related infection in patients with breast cancer，found the best evidence and applied it in clinical practice to reduce the incidence of infection.Methods：Following the JBI clinical evidence practical application model，there were three stages：the previous baseline review，the changes in evidence application practice，and the effect of the application of evidence.Searched for the Chinese and English databases，obtained evidence of the best strategy of preventing arm implantable port-related infection，and 21 pieces of evidence were extracted，and 16 pieces of evidence were adopted according to the FAME structure，which were converted into 16 review indicators，which were applied to clinical practice and evaluated their effects.Results：The incidence arm implantable port-related infection in patients after the application of evidence was lower than before the application of evidence （Plt;0.05），the scores of the nurse and patient knowledge questionnaire were higher than before application （Plt;0.05）.Among the 16 indicators reviewed，except for indicators 3 and 6 and 11-15，the implementation rate reached 100% before the application，and the implementation of the remaining 9 indicators was better than before the application of the evidence （Plt;0.05）.Conclusion：The evidence based practice of prevention of arm implantable port-related infection in patients with breast cancer can reduce the incidence of arm implantable port-related infection，standardize the training of the arm implantable port，and improve the professional knowledge level of nurses and improve the knowledge of infusion tube maintenance of patients.

Keywords breast cancer;arm implantable port-related infection;prevention;evidence-based practice；evidence-based nursing

摘要 目的：開展預防乳腺癌病人上臂植入式輸液港感染的循證實踐，尋找最佳證據并應用于臨床，以降低感染發生率。方法：遵循Joanna Briggs Institute（JBI）臨床證據實踐應用模式，包括基線審查、證據轉化并應用于臨床實施變革、證據應用后審查3個階段。檢索中英文數據庫，獲取預防上臂植入式輸液港感染最佳策略的證據，提取出21條證據，根據FAME結構采納其中16條證據，轉化為16條審查指標，應用于臨床實踐并評價其效果。結果：證據應用后，病人上臂植入式輸液港感染發生率低于證據應用前（Plt;0.05），護士及病人上臂植入式輸液港知識調查問卷得分高于證據應用前（Plt;0.05），16條審查指標，除指標3、6、11～15執行率在證據應用前已達100%，其余9項審查指標執行情況均優于證據應用前（Plt;0.05）。結論：預防上臂植入式輸液港感染的循證實踐可降低感染發生率，規范上臂植入式輸液港的培訓和管理，提高護士專業知識水平，提高病人輸液港維護知識掌握程度。

關鍵詞 乳腺癌；上臂植入式輸液港感染；預防；循證實踐；循證護理

doi：10.12102/j.issn.2095-8668.2024.19.009

輸液港又稱植入式給藥裝置，在乳腺癌化療病人中應用廣泛。2016年，國外學者首次將上臂植入式輸液港應用于臨床，與傳統胸壁式輸液港比較，上臂植入式輸液港更加美觀，且無氣胸風險，更受乳腺癌病人青睞，雖然優點眾多，但感染仍是其最常見的并發癥，限制了上臂植入式輸液港的推廣應用［1］。上臂植入式輸液港感染包括局部感染和全身感染，發生率高達3%～10%，不僅給病人造成身體上的痛苦，同時增加病人住院時長和費用，嚴重者被迫非計劃性拔管，導致化療被迫中斷，甚者危及病人生命安全。……